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Getting Care They Want, Seniors Flock to Naval Hospital

SAN DIEGO, June 8, 1999  June Mason feels a little shaky, a little teary, a little relieved as she waits to see her doctor at the Naval Medical Center here.

Shaky, because her husband, Charles, a retired Navy captain, had just come off a ventilator in his slow, steady recovery from heart surgery and follow-on complications. Teary, because doctors here hadn't given her much hope, but now there's a glimmer of hope. Relieved, because she's thankful for the excellent medical treatment he's received, that they've both received, in the hospital in the town they've called home since 1971.

"He died on the operating table May 3," June said, wiping unwanted tears from her bright, kind eyes. "It took them 45 minutes to restart his heart, but they did. And he was going to be OK.

"Then he got a staph infection and that really hurt. The doctors didn't think he was going to make it, and they're surprised he showed signs of recovery. I'm so grateful. He just might make it now. There's a chapel up there next to the ICU. I go there every day and pray for him. I know it helps."

The Masons are lucky, June said, because they've always been able to come here for their health care. Even after they signed up with a civilian health maintenance organization, they could still get their care here on a space-available basis. "They never failed to get us in," she spoke softly from the narrow, softly lit examining room.

Then DoD announced it would test a new program here called TRICARE Senior Prime. It's a demonstration to see if the military can provide care for Medicare-eligible patients cost- effectively. As a result, some of the clinics the Masons and other retirees over age 65 use said they couldn't come here anymore unless they signed up for Senior Prime.

"We didn't hesitate," June said. "We're very comfortable with the doctors here and with the staff -- the nurses and corpsmen. They are caring people."

In fact, Senior Prime was born here out of an idea put forth by three retired officers who saw a promise of "free health care for life" being broken by military budget and staff reductions. June might also want to thank retired Army Cols. Walt Mikulich and George Smith and retired Navy Dr. (Capt.) John Howard. It was their idea that DoD should be directly reimbursed by Medicare for health care given to older retirees and their spouses.

They called their plan for Medicare reimbursement "Subvention," after a term used in California to describe a transfer of a state-paid veterans benefit to federal control. It was a very simple concept, Smith said. "If the federal government pays Medicare fees and it pays military fees, why can't it pay Medicare fees to military hospitals?"

"Walt Mikulich came to me in 1995 and showed me the language in the various legislative bills that would create 'Medicare Subvention,'" Cmdr. Daniel Wasneechak said. A registered nurse put in charge of administering Senior Prime, Wasneechak now oversees the result of their efforts to retain military health care. In 1998, the San Diego Naval Medical Center became one of six sites nationwide demonstrating subvention.

As of June 3, 3,010 eligible retirees and spouses had signed up toward a demonstration cap of 4,000, which Wasneechak said the hospital will reach by the end of summer.

Senior Prime is not what Mikulich and company had in mind. They had envisioned a much simpler, straightforward system than the one eventually agreed to by the federal Health Care Financing Administration, which manages Medicare. They also expected over- 65 retirees, like other TRICARE beneficiaries, to be able to choose from fee-for-service, preferred provider and health maintenance organization options. Senior Prime offers only the tightly controlled and restrictive -- but cheaper -- HMO option.

Although the three retirees aren't totally happy, Senior Prime is a pretty good deal, Wasneechak said. "The only cost to Senior Prime enrollees is Medicare B, which is about $44 a month," he said. "The care they receive in the military treatment facility is free, including inpatient care. Active duty members will always have first priority for care. TRICARE Prime enrollees get the second priority, and Senior Prime enrollees are included in this group."

The demonstration is slated to end Dec. 31, 2000. However, several new bills pending in Congress could make the demonstration permanent. One of the bills would give the senior retirees a fee-for-service option, the choice Howard said the "founding fathers of Subvention" think is absolutely necessary.

"Many of us have [nonmilitary] physicians we really like, but if you sign up for this, you have to get your care here," Howard said. "For somebody who can't afford Medicare cost-shares, this is very good. But we should have a choice like any other health plan offers."

If the Primary Care waiting room is any indication on this early June afternoon, however, many seniors are happy with the new arrangement. More than a dozen, some clearly in need of health care, have filled the waiting room or are queued at the front desk.

"Everybody for the most part loves the program," Wasneechak said. "They like being seen by military doctors. We offer more respect for the patients and their military backgrounds. We address them by their military rank. They have a sense of pride in their past service and like it better than just being 'Mr. Jones' downtown.

"We are trying to keep the promise to these beneficiaries to give them free health care for life," Wasneechak said. "We can't really give them the free benefit, but this is the next best thing."

Caring for older patients isn't only just, it's good for military medicine, said Mason's physician, Navy Dr. (Capt.) Joel Lees.

"The patients in Senior Prime tend to be patients with diseases and sicknesses we don't routinely see in the younger, healthier military population," Lees said. "Caring for the older retirees helps us maintain medical skills that are critical to our readiness to treat troops in the field. That's a challenge the military needs."

And so June Mason waits briefly, before Lees goes in to see her. Her blood pressure's been up lately -- "not surprisingly, considering everything," she adds. Lees reviews cards she's brought with her showing her blood pressure readings since she last visited him.

"This looks better, much better," he assures her. "You're doing fine, just fine. How have you been feeling? "

And there's a wife pushing her husband down the hall in his wheelchair for his appointment. Outside, more Senior Prime patients move slowly toward the clinic and toward the care they want and need and know they deserve and are happy now to be getting. At last. At their favored hospital in the town they call home.

June Mason listens as Navy Dr. (Capt.) Joel Lees discusses her blood pressure readings with her during a follow- up appointment at Naval Medical Center San Diego. Mason and her husband, retired Navy Capt. Charles Mason, enrolled in DoD's TRICARE Senior Prime demonstration to be able to continue getting all their health care from the military. "We're very comfortable with the doctors here," she said. Douglas J. GillertDownload screen-resolutionDownload high-resolution

Elderly patients await appointments at Naval Medical Center San Diego, where they've enrolled in TRICARE Senior Prime, a test of DoD's ability to deliver cost-effective health care to Medicare-eligible beneficiaries. More than 3,000 have enrolled in the pilot program here and thousands more at five other test sites across the country. Douglas J. GillertDownload screen-resolutionDownload high-resolution